Pain Management Options for Childbirth

Reducing pain for childbirth is a team-approach at Melrose-Wakefield Hospital. From our obstetricians, anesthesiologists, pediatricians, family practitioners, nurses and childbirth educators, you can expect quality care, flexible routines and a desire to help you deliver your baby with as much comfort as possible.

In order for families to make the best possible decisions for themselves regarding pain control, it is necessary to be as educated as possible about all options. Uncontrolled pain sometimes makes labor difficult and may produce unnecessary stress on the baby. Your professional team of doctors and nurses can provide you with many options for reducing pain from conditioned breathing to epidural anesthesia.

Holistic Techniques

Since the 1950’s in this country, women and their labor partners have been using a variety of non-medical interventions to decrease pain in labor. Through our childbirth education classes you will be taught breathing exercises, relaxation skills, visualization, positions and comfort measures for labor and birth. These techniques have been proven to help reduce pain and can be used with or without medications and anesthesia.

Narcotic Pain Medication

These medications are a common form of pain relief during labor. They are most commonly given during the active phase of labor (4-plus cm. dilation) and can be administered by shot or IV. These drugs dull the pain, rather than eliminate it, and have few side effects. They can be used in conjunction with conditioned breathing, relaxation techniques, and other medication and anesthesia.

Epidural Anesthesia

This technique is extremely safe and very effective, having improved greatly over the past 15 years. Today, fewer anesthetics are used than in the past so that while the mother’s pain is diminished, she can still feel contractions and push in a coordinated fashion. She will receive the epidural once labor is established and will continue to feel its effect until the baby is born.

With an epidural, a local anesthetic is delivered into the epidural space in the lower back via a tiny catheter attached to a continuous infusion pump. An epidural has several significant advantages. First, the medications stay within the epidural space, blocking pain signals to the brain without entering the blood stream. Virtually miniscule amounts of the medication get to the fetus, so the patient has pain relief with minimal medication exposure to the baby.

The use of intravenous fluids along with the epidural technique also improves the mother’s blood pressure, ensuring the baby continues to get a strong supply of blood. By eliminating the mother’s pain, the body’s physiological response to stress, which constricts blood flow, is removed.

Should something untoward happen, the anesthesiology team has the ability to rapidly raise the level of anesthetic to do an emergency Cesarean section within a few minutes without having to put the mother to sleep using general anesthetic.

The relative risks are few, including: a drop in blood pressure (countered by giving I.V. fluids), nausea and, as with any invasive procedure, infections which are all managed through precautions and treatments, making the risks very minor.

Epidural anesthesia will continue throughout the pushing stage of labor with the catheter infusion pump, allowing pain relief and muscle coordination. Positions, comfort measures and conditioned breathing can be used to enhance pain relief.

Local Anesthesia

Local perineal or pudendal is given at the time of delivery to numb in and around the vaginal area for the delivery of the baby. Your doctor will administer this anesthesia by a shot into the perineum. The medication is a Novocain-like drug that will provide relief of pain as the baby’s head emerges and will provide additional relief if any suturing of the perineal tissues is required after birth.

Spinal Anesthesia

The situation often determines the choice of pain control options. Spinals, unfortunately, have an outdated reputation for causing spinal headaches, which is no longer the case. In the past, one in five women had spinal headaches; now it is one in three hundred. Spinals differ from epidurals in the location that the medications are injected.

In spinal anesthesia, medication is injected into the spinal space. With the spinal, the mother is awake, but has numbness below the chest level. Sodium citrate (antacid) will be given to reduce gastric upset.

General Anesthesia

This anesthesia is used in emergency situations for C-deliveries where other anesthesia options are not possible. It is done very rarely (less than 2 percent of deliveries). During a Cesarean delivery using general anesthesia, the mother is asleep and the child is delivered quickly. Partners must wait for mom and baby outside of the operating area in labor and delivery.

Please remember that every pregnant woman is unique and should discuss all questions and concerns with her healthcare practitioner. Information about medical options is available in your childbirth classes.

To register for childbirth classes call 781-338-7561.

To speak with an anesthesiologist, call 781-979-3706.

Other Medications

During labor it might be necessary for your healthcare professional to prescribe other medications that might include antibiotics, (for control or prevention of infection), anti-nausea medications (to offset this side effect of labor), labor enhancing chemicals such as Pitocin ( a synthetic hormone to increase the effect of labor contractions)or prostaglandin gels (to help prepare the cervix for labor). These will be discussed and explained during your childbirth classes and you should talk to your practitioner about them.

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